Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad
A 72 year old male with an abnormal prostate exam but normal PSA.
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1. Question
A 72 year old male presents with an abnormal prostate exam, but normal PSA. What is the diagnosis?
Correct
Correct Answer: B
Histology: The lesion consists of glands with solid nests composed of cells with basophilic nuclei with scant cytoplasm. Some of the nests have a small glandular lumina. There is no necrosis or reaction of the stroma.
Discussion: Basal cell hyperplasia consists of glands with basophilic nuclei and scant cytoplasm and increased number of the basal layer, from a double-layer up to solid nest. It can range from small focal areas to florid. Glands can appear to form cribriform/pseudocribriform structures, but are actually small round hyperplastic glands crowded together. Well-formed lamellar intraluminal calcifications can be observed, which is extremely rare in carcinoma. Intracytoplasmic eosinophilic globules can also be present. The most frequent location is in the transition zone and therefore are more commonly seen in transurethral resections. In needle biopsies, the glands may appear to have an infiltrative growth pattern. Basal cell hyperplasia may have prominent nucleoli, further mimicking cancer. If cancer is suspected, immunohistochemistry is helpful in the differential diagnosis with adenocarcinoma because BCH is positive for basal cell markers, and negative for racemase. The differential diagnosis of BCH should also include basal cell carcinoma. The features that are seen in carcinoma but not in hyperplasia include large nests with necrosis, adenoid cystic pattern, variable sizes and shapes of the nests with infiltrating borders, extraprostatic extension or bladder neck invasion, and desmoplastic stromal reaction. Occasionally, basal cell hyperplasia can involve bladder neck muscle or present between normal prostatic glands, therefore these findings should not be considered in isolation, sufficient to make a diagnosis of carcinoma. By immunohistochemistry, diffuse staining for Bcl-2 and elevated Ki67 correlate have been reported to be associated with carcinoma and not hyperplasia.
References:
Am J Surg Pathol. 2002;26(2):237-243.
Am J Surg Pathol. 1992;16(12):1205-1214.
Hum Pathol. 2005;36(5):480-485.
Incorrect
Correct Answer: B
Histology: The lesion consists of glands with solid nests composed of cells with basophilic nuclei with scant cytoplasm. Some of the nests have a small glandular lumina. There is no necrosis or reaction of the stroma.
Discussion: Basal cell hyperplasia consists of glands with basophilic nuclei and scant cytoplasm and increased number of the basal layer, from a double-layer up to solid nest. It can range from small focal areas to florid. Glands can appear to form cribriform/pseudocribriform structures, but are actually small round hyperplastic glands crowded together. Well-formed lamellar intraluminal calcifications can be observed, which is extremely rare in carcinoma. Intracytoplasmic eosinophilic globules can also be present. The most frequent location is in the transition zone and therefore are more commonly seen in transurethral resections. In needle biopsies, the glands may appear to have an infiltrative growth pattern. Basal cell hyperplasia may have prominent nucleoli, further mimicking cancer. If cancer is suspected, immunohistochemistry is helpful in the differential diagnosis with adenocarcinoma because BCH is positive for basal cell markers, and negative for racemase. The differential diagnosis of BCH should also include basal cell carcinoma. The features that are seen in carcinoma but not in hyperplasia include large nests with necrosis, adenoid cystic pattern, variable sizes and shapes of the nests with infiltrating borders, extraprostatic extension or bladder neck invasion, and desmoplastic stromal reaction. Occasionally, basal cell hyperplasia can involve bladder neck muscle or present between normal prostatic glands, therefore these findings should not be considered in isolation, sufficient to make a diagnosis of carcinoma. By immunohistochemistry, diffuse staining for Bcl-2 and elevated Ki67 correlate have been reported to be associated with carcinoma and not hyperplasia.
References:
Am J Surg Pathol. 2002;26(2):237-243.
Am J Surg Pathol. 1992;16(12):1205-1214.
Hum Pathol. 2005;36(5):480-485.
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